November 1, 2013
The Honorable Barack Obama President of the United States The White House 1600 Pennsylvania Avenue NW Washington, DC 20500
Dear President Obama:
We are writing to you as individuals who are or have been leaders in major U.S. health institutions, as well as medical education, ethics, and research, and who are deeply invested in maintaining the principles of ethics and professionalism in American medical practice . We believe that the practice of force-feeding hunger strikers at Guantánamo Bay severely breaches those principles and undermines medical care at the detention center. While a Department of Defense release claims that mass hunger strikes have largely ended at Guantánamo, individual detainees remain on hunger strikes and protocols issued by command continue to authorize force-feeding. We urge you to put the practice to a stop and repeal protocols that authorize it.
As international and domestic standards for physician response to hunger strikes emphasize, the essential role of physicians in such cases is to maintain their doctor-patient relationship with the detainee, meet the patient’s medical needs, and counsel the patient. Respect for the patient’s decision-making, which is the foundation of trust between doctor and patient, is essential. Moreover, taking this approach can contribute to reducing the tension between prisoners and administrators and – in some cases – aid in the resolution of the underlying dispute. Force-feeding is utterly incompatible with these professional values, which is why the World Medical Association and the American Medical Association condemn its use.
Force-feeding undermines appropriate medical care and ethical responsibilities because physicians act as agents of command, a fundamental violation of professionalism. Detainees’ choices are not respected. Worst of all, a command protocol calls for the use of five-point restraints – twice a day for up to two hours – for the purpose of force-feeding. We agree with the president of the American Medical Association, James Lazarus, who wrote in the British Medical Journal that “in the AMA’s view, the use of restraints to force-feed detainees is an inhumane and degrading intervention that falls within the prohibition of torture.”
It is sometimes claimed that force-feeding is necessary to save lives. But the experience of countries that eschew force-feeding, including the United Kingdom and Israel, is that following ethical standards and adhering to medical professionalism does not result in the deaths of prisoners. We urge you to bring in physicians not beholden to commanders who can establish a relationship of trust with detainees, provide care in accordance with our traditions of professionalism, and respect ethical requirements.
In your June speech on national security, you said in reference to force-feeding, “Is this who we are? Is that something our founders foresaw? Is that the America we want to leave our children?”
The Honorable Barack Obama November 1, 2013 Page 2
We would answer a firm “No.” This practice is inconsistent with American values and the medical values and professional responsibilities that are so central to the role physicians, including military physicians, play in our society, no matter who the patient is.
It is time for the Administration to reaffirm our values, respect the human rights of detainees, and restore the ability of doctors to adhere to their clinical and ethical responsibilities by ending the force-feeding of hunger strikers.
Sincerely yours,
Deborah Ascheim, MD – Associate Professor in Departments of Health Evidence and Policy and Medicine/Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; Chair of the Board of Directors, Physicians for Human Rights
Herbert L. Abrams, MD, FACR, FACC, FAAS – Philip H. Cook Professor and Chairman of Radiology Emeritus, Harvard Medical School; Professor Emeritus of Radiology, Stanford University School of Medicine; Founding Vice-President, International Physicians for the Prevention of Nuclear War
Eli Adashi, MD, MS – Professor of Medical Science, Former Dean of Medicine and Biological Sciences, Warren Alpert School of Medicine, Brown University
Peter Agre, MD – University Professor and Director of Molecular Microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health; Recipient of the 2003 Nobel Prize in Chemistry
Scott Allen, MD, FACP – Clinical Professor of Medicine and Associate Dean of Academic Affairs at University of California-Riverside; Former Medical Program Director, Rhode Island Department of Corrections
Neal Baer, MD – Executive Producer
Elizabeth Blackburn, PhD – Morris Herzstein Professor in Biology and Physiology in the Department of Biochemistry and Biophysics at University of California-San Francisco; Recipient of the 2009 Nobel Prize in Physiology or Medicine
Craig Blakely, PhD, MPH – Dean, University of Louisville School of Public Health and Information Sciences
Richard Carmona, MD, MPH, FACS – 17th Surgeon General of the United States
G. Thomas Chandler, MSc, PhD – Dean, Arnold School of Public Health at the University of South Carolina
Jane Clark, PhD – Professor and Dean, University of Maryland - College Park School of Public Health
Frank Davidoff, MD, MACP – Editor Emeritus Annals of Internal Medicine and Institute for Healthcare Improvement; former Interim CEO, Physicians for Human Rights
The Honorable Barack Obama November 1, 2013 Page 3
Felton Earls, MD – Professor of Social Medicine Emeritus at Harvard University, Research Professor of Human Behavior and Development, Harvard School of Public Health; Member of Human Rights Committee at National Academy of Sciences
Ruth Faden, PhD, MPH – Philip Franklin Wagley Professor of Biomedical Ethics and founding Director of the Johns Hopkins Berman Institute of Bioethics
John Finnegan, Jr., PhD – Dean, University of Minnesota School of Public Health
Jeffrey S. Flier, MD – Dean of the Faculty of Medicine, Caroline Shields Walker Professor of Medicine, Harvard Medical School
Howard Frumkin, MD, DrPH – Dean, University of Washington School of Public Health
H. Jack Geiger, MD, M Sci Hyg – Arthur C. Logan Professor of Community Medicine Emeritus at City University of New York; Founding Member and Past President, Physicians for Human Rights
Lynn Goldman, MD, MS, MPH – Dean, The George Washington School of Public Health and Health Services
Roger Guillemin, MD, PhD – Distinguished Scientist at the Salk Institute (La Jolla, CA); Recipient of the 1977 Nobel Prize in Medicine or Physiology
Howard Hiatt, MD – Professor of Medicine, Harvard Medical School, and Former Dean, Harvard School of Public Health
Pascal James Imperato, MD, MPH, TM – Dean and Distinguished Service Professor, Downstate Medical Center School of Public Health at the State University of New York
Michael J. Klag, MD, MPH – Dean, Johns Hopkins Bloomberg School of Public Health
Richard Kurz, PhD – Professor and Dean, University of North Texas Health Science Center School of Public Health
Robert S. Lawrence, MD, MACP, FACPM – Center for a Livable Future Professor of Environmental Health Sciences, Health Policy and International Health, Johns Hopkins Bloomberg School of Public Health
Jay Maddock, PhD, FAAHB – Professor and Director, Office of Public Health Studies, University of Hawaii at Manoa
Robert Meenan, MD, MPH, MBA – Dean, Boston University School of Public Health
Philip C. Nasca, PhD – Dean, University at Albany SUNY School of Public Health
David G. Nathan, MD – President Emeritus Dana-Farber Cancer Institute; Physician-in-Chief Emeritus Boston Children’s Hospital; Robert A Stranahan Distinguished Professor of Pediatrics Harvard Medical School The Honorable Barack Obama November 1, 2013 Page 4
Martin Philbert, PhD – Dean, University of Michigan School of Public Health
Paul Brandt-Rauf, DrPH, MD, ScD – Dean, University of Illinois at Chicago School of Public Health
Irwin Redlener, MD – Earth Institute, Professor of Policy, Management, and Pediatrics at Columbia University
Barbara Rimer, DrPH, MPH – Dean and Alumni Distinguished Professor, University of North Carolina at Chapel Hill, Gillings School of Public Health
Sir Richard Roberts – Chief Scientific Officer at New England Biolabs; Recipient of the 1993 Nobel Prize for Physiology or Medicine
Carleen Stoskopf, ScD – Director, Graduate School of Public Health, San Diego State University
Jack Szostak, PhD – Professor of Genetics, Harvard Medical School; Recipient of the 2009 Nobel Prize in Medicine or Physiology
Paul Volberding, MD – Director of University of California, San Francisco AIDS Research Institute and Director of Research for University of California, San Francisco Global Health Sciences
Torsten Wiesel, MD – President Emeritus, Vincent and Brook Astor Professor Emeritus at Rockefeller University; Recipient of the 1981 Nobel Prize in Physiology or Medicine
Stephen N. Xenakis, MD – Brigadier General (Ret), U.S. Army
*All signatories have signed in their personal capacities; institutional affiliations are noted for identification purposes only.
Please direct all correspondence regarding this letter to:
Deborah Ascheim, MD c/o Physicians for Human Rights 1700 Broadway, 17th Floor New York, NY 10019